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Public Moralities Concerning Donation and Disposition of Organs: Results from a Cross-European Study


There are not many international consensuses in the governance of biomedicine. One that exists concerns a general reluctance toward a commercialization of organ procurement. However, with reference to the problem of “organ scarcity,” there is an increasingly louder call in ethical and legal discourse to “give urgent consideration to any option that may make up the shortfall,” and to establish a debate on financial incentives “without any taboos.” Other ethicists and jurists criticize this development, and warn of injustice, exploitation of the poor, and a commodification of the human body.

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1 Erin C, Harris J. An ethical market in human organs. Journal of Medical Ethics 2003;29:137–9.

2 Breyer F, van den Daele W, Engelhard M, Gubernatis G, Kliemt H, Kopetzki CH, et al. Organmangel. Ist der Tod auf der Warteliste unvermeidbar? Berlin: Springer; 2006.

3 For an overview, see Simmerling M, Angelos P, Franklin J, Abecassis M. The commercialisation of human organs for transplantation: The current status of the debate. Current Opinion in Organ Transplantation 2006;11:130–5.

4 See Gold S, Schulz KH, Koch U. Der Organspendeprozess: Ursachen des Organmangels und mögliche Lösungsansätze. Inhaltliche und methodenkritische Analyse vorliegender Studien. Eine Expertise im Auftrag der Bundeszentrale für gesundheitliche Aufklärung (BZgA). Forschung und Praxis der Gesundheitsförderung. Band 13. Köln: BZgA; 2001.

5 See Haddow G. “Because you're worth it?” The taking and selling of transplantable organs. Journal of Medical Ethics 2006;32:324–8.

6 See Morgan DL. Focus Groups as Qualitative Research. Thousand Oaks, CA: Sage; 1997.

7 See Bohnsack R. Rekonstruktive Sozialforschung—Einführung in Methodologie und Praxis qualitativer Forschung. Opladen: Leske und Budrich; 2000.

8 The two German focus groups were recruited, organized, and conducted by the Research Group Bioethics and Science Communication at the Max Delbrück Center for Molecular Medicine Berlin-Buch. The two Cypriot focus groups were recruited, organized, and conducted by the Department of Clinical Genetics at the Archbishop Makarios III Medical Centre. The two Dutch focus groups were recruited, organized, and conducted by the Department of Philosophy at the University of Utrecht. The two Swedish focus groups were recruited, organized, and conducted by the Department of European Ethnology at the University of Lund. All groups were recruited, organized, and conducted in early 2005, following the guidelines for setting and content of the EU Project “Challenges of Biomedicine,” Contract No. SAS6-CT-2003-510238.

9 See State of the Art-Report Cyprus, produced by V. Anastasiadou and C. Constantinou within the framework of the EU-Project “Challenges of Biomedicine,” Contract No. SAS6-CT-2003-510238.

10 For more details on the procedures of data collection, see the Local Focus Group Reports available from Challenges of Medicine (homepage on the Internet). Department of Social Studies of Science, Faculty of Social Sciences, University of Vienna; available at (accessed 30 July 2007).

11 Strauss A, Corbin J. Basics of Qualitative Research. Grounded Theory Procedures and Techniques. Newbury Park, CA: Sage; 1990.

12 See note 2, Breyer et al. 2006.

13 See note 4, Gold et al. 2001.

14 Focus Group Sweden (lay people), female speaker A.

15 Focus Group Germany (affected people), male speaker B.

16 For an overview, see Gutmann T. Reimbursement, rewarded gifting, financial incentives and commercialism in living organ donation. In: Collins GM, Dubernard JM, Persijn GG, Land W, eds. Procurement and Preservation of Vascularized Organs. Dordrecht: Kluwer Academic Publishers; 1997:301–16.

17 Focus Group Germany (lay people), female speaker C.

18 Focus Group Cyprus (lay people), female speaker D.

19 Focus Group the Netherlands (lay people), male speaker E.

20 Focus Group Sweden (lay people), female speaker F.

21 See Joralemon D, Cox P. Body values: The case against compensating for transplant organs. Hastings Center Report 2003;33(1):2733.

22 Focus Group Germany (lay people), male speaker G.

23 Focus Group the Netherlands (lay people), male speaker E.

24 Focus Group the Netherlands (lay people), male speaker H.

25 See Daar AS. Rewarded gifting. Transplantation Proceedings 1992;24:2207–11.

26 See Schicktanz S, Schweda M, Franzen M. “In a completely different light”? The role of being affected for epistemic perspectives and moral attitudes of patients, relatives and lay people. Medicine, Health Care and Philosophy 2008;11(1):5772.

27 See Wilkinson S. Commodification arguments for the legal prohibition of organ sale. Health Care Analysis 2000;8:189201.

28 Campbell CS. Body, self, and the property paradigm. Hastings Center Report 1992;22(5):3442. Williams-Jones B. Concepts of personhood and the commodification of the body. Health Law Review 1999;7(3):11–3.

We thank Annika den Dikken (Utrecht), Beate Herrmann (Tübingen), and Aviad Raz (Beer Sheva) for comments and critique and Susan Nurmi-Schomers and Bob Fendrich for instructive comments on language.

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
  • URL: /core/journals/cambridge-quarterly-of-healthcare-ethics
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